[Surgeons learn how to learn. Study of 76,499 herniorrhaphies performed between 1993 and 1997 registered by the chamber of physicians in Westfalia-Lippe].

INTRODUCTION: New techniques require "new" surgeons who are able to apply them safely. The bushfire-like employment of laparoscopic cholecystectomy confronted a community of surgeons totally inexperienced in that technique. Thus, the collective learning curve was paralleled by a temporary increase of postoperative complications. The aim of the following study was to analyze the learning curve for laparoscopic herniorrhaphy with regard to the complication rates during that period.
METHODS: A total of 76,499 questionnaires from the external quality assurance of the Westfalia-Lippe physicians board registered between 1993 and 1997 were analyzed retrospectively. The parameters (duration of the operation and hospitalization, ASA classification, rate of obese patients, intra- and postoperative complications) were analyzed and plotted as a synchronized learning curve of the whole group of surgeons.
RESULTS: As for laparoscopic cholecystectomy, a learning curve was found for laparoscopic herniorrhaphy, which could be attributed to a decreasing duration of the procedures and increasing ASA classification and rate of morbid obese patients while complication rates were kept constantly low. After 9 months of application laparoscopic hernia repair seemed to have been introduced to a new collective of surgeons while learning parameters showed inverse trends for a short period of time. The complication rate of laparoscopic hernia repair was constantly lower than in routine open inguinal hernia repair.
CONCLUSION: Since laparoscopic inguinal hernia repair is a demanding method, surgeons apparently did not forget the lessons learned from the introduction of laparoscopic cholecystectomy as they were able to avoid increasing intra- and postoperative complication rates during their learning curve. Surgeons are learning to learn.